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Approval Period: April 1, 2019 through December 31, 2028 Page 24 of 28

Topic Measure [Reported for each month included in the annual report] Utilization Monitoring Unduplicated Number of Enrollees by Quarter (See table 2 below) Unduplicated Number of Beneficiaries with any Claim by Age Group, Gender, and Quarter (See table 3 below) Contraceptive Utilization by Age Group (See table 4 below) Total Number of Beneficiaries Tested for any Sexually Transmitted Disease (See table 5 below)

Total Number of Female Beneficiaries who Obtained a Cervical Cancer Screening (See table 6 below) Total Number of Female Beneficiaries who Received a Clinical Breast Exam (See table 7 below)

Table 2: Unduplicated Number of Enrollees by Quarter

Number of Female Enrollees by Quarter 14 years old and under 15-20 years old 21-44 years old 45 years and older Total Unduplicated Female Enrollment* Quarter 1

Quarter 2

Quarter 3

Quarter 4

*Total column is calculated by summing columns 2-5.

Table 3: Unduplicated Number of Beneficiaries with any Claim by Age Group and Gender per Quarter in the Demonstration Year

Number of Females Who Utilize Services by Age and Quarter 14 years old and under 15-20 years old 21-44 years old 45 years and older Total Female Users * Percentage of Total Unduplicated Female Enrollment Quarter 1

Quarter 2

Quarter 3

Quarter 4

Total Unduplicated**

*Total column is calculated by summing columns 2-5. **Total unduplicated row cannot be calculated by summing quarter 1 – quarter 4. Total unduplicated users must account for users who were counted in multiple quarters, and remove the duplication so that each user is only counted once per demonstration year.

Table 4: Contraceptive Utilization by Age Group per Demonstration Year Effectiveness Users of Contraceptives